Picture taken during the symposium showing Prof. Matthias Rose explaining the timeline of patient’s questionnaires and follow-up.

Under the lead of Prof. Christoph A. Meier, the first national symposium on value-based healthcare took place at the Basel University Hospital. Gathering several speakers, it allowed us to have a deep dive into Value-based healthcare and its implementation in the hospital setting.
We know today that the healthcare system doesn’t work properly in terms of quality and prices. It needs to switch from volume to value not only from a mindset perspective but also from a payment standpoint.Beside initiatives like Smartermedicine and Lean, Value-based healthcare is necessary today to make our healthcare system more sustainable.

Keynote – Value-based health care

Dr Jens Deerberg-Wittram

Taking the Dunning-Kruger effect showing the link between incompetence and self-confidence, he showed how we could potentially explain significant mortality rate differences between hospitals in Switzerland (and everywhere else in the world). When you are inexperienced, you tend to be self-confident. The more experience you are getting, the more you are losing confidence to get it back after some time.

Dunning-Kruger is linked to 3 elements:
– People underestimate risk and complexity
– People overestimate their ability
– People never reach out for help
It is linked to quality problems and outcome issues in the hospital setting.

The other problem is how much money we spend to achieve those poor outcomes. Healthcare costs currently grow faster than the GDP. That deviation puts the question of the sustainability of the system at the center. None of the solutions we tried seem to work: more competition (US) or public centralization (Sweden) lead both to increased costs. In a nutshell, the financial challenges in healthcare cannot be solved by a political solution.

Michael Porter, in his book Redefining healthcare shows that value has 2 components: 1/ health outcomes that matter to patients and 2/ cost to deliver the outcomes.
Outcome measurement the first step towards value-based healthcare. In order to do so, healthcare organizations should start to measure quality and reduce variation in patient outcomes. Then the standardization of the outcome metrics will enable comparisons across and within health systems. Public reporting and transparency will support the continuous improvement of the system, especially if reimbursement is closely linked to the patient outcomes.

Outcomes measurements should also be uniformly and internationally defined. ICHOM provides standard sets for outcomes measurements by therapeutics area / disease. With already 23 standard sets developed covering 50% of the global disease burden, ICHOM is also working on having adult and pediatric sets for multi-morbid patients (preventing them from receiving questionnaires for each pathology they have).
Financial incentives to improve value could be implemented through several models: bundle payment, complication guarantee, result-dependent payment.
Bundle payments are the most appropriate model to finance care. In Sweden, the money the hospital gets will depend on the pain the patient is feeling 6 months after the surgery. 40% of the revenue could be tied to patient reported outcomes. Risk-sharing agreement are also part of the landscape.

The Economy of VBHC for the Payers

Prof Thomas Szucs, Helsana

It is important to be more fact-based and not anymore policy-based. Value-based healthcare is an evolutionary process.
It could start by using data that we already have. Helsana did a study to evaluate performance indicators for chronic disease in alternative insurance models. They saw differences and were willing to understand the underlying reasons of those variations? In diabetes and cardiovascular disease, they could see statistically significant difference in the reduction of hospitalization by 13 and 8%, respectively. But it was not the case for asthma.

Pharmaceuticals are an innovation that could prevent expensive hospitalization in asthma, for example. However, where does value come in? In an efficient, market price is regulated through supply and demand but healthcare is not a normal market (beneficiaries do not pay or decide; there is information asymmetry and a need to build capacity to protect from potential economic downside).

You need clinically meaningful differences to determine the extent of innovation. But very often price does not reflect value as there are price regulations, price referencing schemes and health technology assessments.

Implementation of ICHOM at the USB

Prof Marcel Jakob, Prof Walter Weber

The real case of the implementation of ICHOM at the Basel University Hospital in two areas:

Breast surgery
The goal was really to improve the quality of life and aesthetic outcomes for breast surgery.
ICHOM was chosen because of the standards defined by the team. Using the best tools and the most appropriate questionnaires as well as KPI (oncoplastic breast conservative surgery) allows doctors to have the most useful and actionable feedback from patients. Patient reported outcomes should be measured in everyday standard clinical practice.
ICHOM allows patient reported outcomes measures (PROM) to be benchmarked among institutions. PROM are also discussed with the patient to refine further treatment and refer her to the appropriate specialist.
Implementation phase was supported by intensive collaboration between chief medical office and clinicians. It follows the clear path of Plan-Do-Check-Act in 6 steps:
– Initial discussion
– Kick off with the team
– Realization
– Reviews, attend consultation hours
– Adaptations on the process
– Evaluation, key learnings and handover to the clinic
1 year later: 97% of patients are included in ICHOM. It is widely accepted by patients (close to 95%).

Orthopedics
Orthopedic implementation of ICHOM at USB for hip replacement. The main expectation were quality-based: indication, perioperative management, surgical performance and postoperative care.
In a nutshell, the quality of life is expected to be better after the treatment. However, there were some challenges, especially the additional workload because of different types of patients.
Quality control is an effort that has to be supported by all staff members. Filling a questionnaire on the iPad could be difficult for some people sometimes because of the technology or because of the type of questions. Personnel should be available to help the patient; otherwise, there is an increased risk of drop-out. To improve the acceptance of the questionnaire, it needs to be adapted and shortened.
It is important to explain why those studies are important in order to recruit and motivate patients to follow up and be committed.
Opinion of patient could change based on to whom they speak. It is fundamental to interact with the patient to find out her/his true opinion.
Good visualization of PROM allows doctors to focus on the patient’s problems and to factually show improvement or deterioration of the health and well-being.

VBHC for Depression & Anxiety

Prof Matthias Rose

Depression and anxiety are the most frequent disorders (#2 for depression and #7 for anxiety in global burden of disease)
Many scales and initiatives are country specific. Howeve, international standardization is fundamental to allow benchmarking as well as best practices implementation. ICHOM promotes an international standardization (see below).

Source: ICHOM website.

Michael E. Porter, the pioneer and founder of Value-based healthcare, sets the definition of value in one of his article as well as the methodology for outcomes measures.

Source: M. E. Porter.

In order to define the most appropriate measures, it is crucial to have the thorough understanding of the disease trajectory. Do we have a comprehensive measure of the disease focused on psychometric soundness, comprehensiveness, the number of available translations but also available royalty free.

Factors for Success and Sustainability of PROMs

Prof Jan A. Hazelzet

How to maintain the success of patient reported outcomes measures (PROM) in the future?
A lot of quality measures currently exist, but the majority is dedicated to processes even if some of them cover quality and outcomes but mainly medical outcomes and few linked to patients.
What are the benefits and the harms that the patient will get from the intervention? This is one of the first question to ask. Growing evidence, supported by the movement Smarter Medicine, goes in the direction of decreasing medical intervention when unnecessary.

There is more than the cost, the flow is equally important as well as the patient experience; and that is value. Focusing on the individual with the disease and not on medical specialties to change the mindset and becoming patient-centric. A team-based approach, in which a team is accountable for the whole process could help set up real care path toward a fully integrated care. It means change for organization and culture.Patient reported outcomes measures means questionnaires because biomarkers and clinical analysis do not consider how the patient really feel. Results of the questionnaires should be discussed with the patient, it will support the commitment and the follow-up of the patient. Visualization is also extremely important for both the patient and the doctor
Overall health sets make sense for multi morbid patients instead of sending the patient 3 different sets.The patient should definitely be considered as a real partner. Patient engagement/involvement is really strong and meaningful. Value based care is patient centered care instead of clinician based. It should be integrated and continuous. A disease team (united, responsible, and accountable) could define a care proposition with data support as well as performance data set. Patients can help with focus groups
Data should be FAIR – findable, accessible, interoperable, reusable

Round Table with Questions & Discussion

– How do you see the integration of GP? The most natural starting point is the identification of conditions where GPs play a crucial role. Integration between GP and hospitals is very crucial. The exchange of information between GPs and hospital is equally important to insure the close follow-up of the patient and the continuity of care. For many patients, the visit to the doctor’s office is very important. Putting iPads on the waiting room to collect some data on the patient that could help the follow up is also crucial.

– Value based care has to be linked to payment and we need to reward institutions that can provide good quality of care. In Switzerland, an experimental article will be approved soon and a pilot project should be launched right after.

– How to manage the fact that people will select always the best surgeon on the list and never go to the last on the list? The transparency will probably be more on the institution level and not specifically on the single doctor. Institutions will be specialized and will do volume in specific procedures. The main incentive should be that healthcare providers offering the same medical specialty talk to each other and share best practices.

– Value-based care should be supported by the doctors or it could not be implemented. Start with clinician champions that can talk and teach to the others.

– Value-based care adds value to the patient file and knowledge on how to better care and follow up with him.

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An amazing Quartz article talks about AI and robotic usage for elderly.

It is a must-read for people not ready to hear that we plan to use robotics instead of real people to interact with elderly in specific conditions. You will read the opinion of a doctor mentioning its use of Paro to calm the anxiety of Alzheimer’s disease patients instead of giving them sedatives.

People concerned about the harm a relationship with Paro might do to a person with dementia do not understand the gravity of the disease, Petersen says. “You come to a point in dementia where you can’t trust yourself,” she says. “It’s like being dropped in another country where you don’t speak the language, you don’t know what time of day it is. It’s terribly, terribly fear-producing. These people live in a constant state of fear because they can’t figure out what to do next. They know something’s wrong but they can’t figure out what it is. And it never ends for them. I don’t think people realize how horrific it is.”

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After decades of lack of innovation in the depression field, maybe patients having tried several treatment options could see the light at the end of the tunnel.

Ketamine is a potent analgesic used in surgery. As the compound is highly soluble in lipids, it ensures a rapid onset of the effects leading to a quick relief of depression symptoms without the typical side effects of standard antidepressants like SSRI.

However, there are some health consequences of administering that drug in the long term:

CNS effects: as ketamine is considered to be a cerebral vasodilator that increases cerebral blood flow, it has anticonvulsant effects. However, its use could be limited as it has also unpleasant emergence reactions such as hallucinations, out-of-body experiences, and increased and distorted visual, tactile, and auditory sensitivity.

Respiratory effects: ketamine relaxes bronchial smooth muscles and may be helpful in patients with reactive airways and in the management of patients experiencing bronchoconstriction.

The cardiovascular effects could limit its used in depressed patients with cardiovascular conditions. Furthermore, we know that ketamine is safe when used for anesthesia but we have no idea about its long-term safety. For depression, it is given every few weeks for several months.

Another point worth to mention is the lack of reimbursement: it is not covered by any health insurance today and patients have to pay out of the pocket. Depending on the dose and the healthcare provider, it could range from USD 400 to 800 in USA.

Currently, late-stage studies are ongoing with compounds closed to ketamine developed by Johnson & Johnson and Allergan in order to fill this gap and provide patients with access to a safe and effective drug.

Thinking forward about mental health, we could maybe study psychoactive drugs more in-depth in order to discover whether they could be used in a controlled setting to ease some mental disorders.

Initiatives are launched to go into this direction. The future will tell…

Psilocybin – A long, strange trip – Because psilocybin research has been restricted, scientists actually don’t know a lot about how it does what it does; only recently has that started to change. To begin with, its chemical structure is similar to the neurotransmitter serotonin. Evidence from a 2012 study suggests that psilocybin “knocks out” serotonin receptors by occupying them, which “appears to allow information to travel more freely in the brain”; two areas in which it knocks out some activity are associated with self-awareness. – Quartz – 2018

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An amazing article posted on the website of the Johns Hopkins Bloomberg School of Public Health details the 100 objects that changed our life, in positive or negative way.

As you will see, you could spend hours discovering those objects and, one by one, you will either discover something you ignored or confirm what you already know. But basically, each one will relate to one aspect of your health.

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Regulators and payers have raised major concerns over recent spikes in drug prices. Unjustified high drug prices (see Valeant case) have triggered not only political comments from U.S. presidential candidates in the previous U.S. elections (see Hillary Clinton’s statement) but also a broader discussion on how drug prices can be regulated and whether the European drug pricing model (reference pricing) should be adopted.

In this article, I will discuss the differences between U.S. and E.U. drug prices based on the case of CNS drugs. Prices have been drawn from various sources including reported Wholesale Acquisition (WAC) prices as well as from a number of journal articles.

The following indications will be analysed: Multiple Sclerosis, Neuropathic Pain and Parkinson’s Disease. These disorders account for ~50% of the global CNS market (excl. psychiatric disorders such as depression, schizophrenia anxiety or eating disorders).

Multiple Sclerosis (MS)

Disease Description: MS is a neurodegenerative disorder in which the insulating covers of…

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The 2016 earnings season is nearly over and some companies gave really excellent performance reports like Bristol-Myers Squibb with 17% organic revenue growth and AbbVie with 13.3% sales growth.

Negative performance for some players like Gilead (suffering base effect linked to a very strong 2015 performance) and AstraZeneca (struggling with a fragmented portfolio unable to drive growth).

In the PDF document (q4-2016), I computed the 2 ratios (operating margin and R&D in % of sales), I also added a column for 2017 guidance follow-up and made some comments on the results, especially the main products and whether I could see any growth driver.

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The earnings season for Big Pharma is now over with Teva publication yesterday.

As usual, a table summarizes the main figures and key points from each publication. Worth noting that some companies like Gilead suffered from a basis effect after a stellar performance last year. Among top performers, Bristol-Myers Squibb, Pfizer and GSK held well during the last quarter. The bottom performers were Gilead, AstraZeneca and Novartis with the last two companies experiencing negative impact from generics.

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Biomimetics are fascinating as, very often, nature is better skilled than humans to solve complex problems. Historically, humans started to look at birds to be able to develop airplanes to fly themselves. Biomimetics applications are extremely wide, especially because of the complexity of biological systems and, also probably, for the reason that scientists have not yet uncovered all the mysteries of Nature itself.

Life sciences would strongly benefit from more Nature-inspired innovations like spider web silk used for artificial ligaments thank to their strength and robustness. Other amazing examples come from the virus world: most viruses have an outer capsule 20 to 300nm in diameter, which are remarkably robust and capable of withstanding temperatures as high as 60 °C; they are also stable across the pH range 2-10. Viral capsules can then be used to create nano device components such as nanowires, nanotubes, and nanomaterial. Last but not least, viruses (in their inactivated form) are very often used as carriers for other molecules and allow the delivery of drugs to very precise locations in the human body.

Biomimetics as innovation method is characterized by interdisciplinary information transfer from the life sciences to technical application fields aiming at increased performance, functionality and energy efficiency.

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The Economist took a deep plunge into mental health research for depression. The article is extremely interesting as it seems that the scientific community understands depression a bit more than before. Despite the lack of interest from the industry, old drugs like ketamine seem to be very useful in treating that disorder. In order to patent their invention, new drugs with the same benefits as ketamine are being developed by pharmaceuticals companies.

Even if we do not yet have a complete picture, we took a step in the right direction.

cancer is a genetic disease: tumors can harbor over 400 somatic mutations

cancer is heterogenous: there are more than 200 types of cancers and a single patient tumor displays intra and inter-tumoral heterogeneity

cancer can metastasize: once spread, it is virually incurable. Metastatic cancer survival at 5 years is extremely low (between 4 and 28%)

Based on those considerations, treatment is becoming much more complex today with a blend of chemotherapy, targeted medicines and immunotherapies. A right combination could extend survival by several months.

But how to develop drugs with increased efficacy against the smart strategies used by the disease (such as tumor angiogenesis)? According to Dr. Pao, 3 elements are necessary:

understanding disease biology as well as druggable targets in the complexity of cancer molecular pathways

developing fit-for-purpose molecules allowing to create the right drug with the right format against the right target

personalizing healthcare with the administration of the right drug to the right patient at the right time

Beyond a better understanding of the disease, using more than a single strategy to target the cancer:

Host directed with cancer immunotherapy. This approach is particularly challenging as some patients do not respond to it (innate or acquired immune escape) and other patients may fully benefit with long term survival

External innovation, collaborations and partnerships, is fully leveraged in order for Roche to complement existing capabilities in the field (immunotherapy examples: CuraDev, Pieris, BluePrint; targeted medicines: Tensha, C4Therapeutics).

As a conclusion, Roche is well positioned to address the cancer challenges and, since the beginning of innovative cancer treatments, the company has always been perceived as the leader of the therapeutic area.

Missing points in his talk were considerations of patient’s quality of life (extending life does not always go with good quality of life because of treatment’s side effects) and drug pricing (adding more and more drugs to the treatment cocktail costs a lot of financial resources, not only paid by the health insurance but also by the patient).

DNA methyltransferase 1 has a role in the establishment and regulation of tissue-specific patterns of methylated cytosine residues. Aberrant methylation patterns are associated with certain human tumors. www.enzymlogic.com. Work done with the molecular visualization VMD program developed at the University of Illinois: www.ks.uiuc.edu/Research/vmd/

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All the big names published their Q2 results during the summer. After spending some time on the beach, looking at their numbers is a good way to be immersed in the industry again.

During this last earnings season, performances were extremely heterogeneous. AbbVie and BMS had stellar revenue growth while AstraZeneca, Gilead and Sanofi showed poor performance for diverse reasons (explained below in the table – NB: you can click on it to make it bigger).

Comparing the Top 15 each quarter is insightful and allows me to spot pockets of growth and dynamism in the industry as well as challenges and red flags.

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I had the opportunity to attend the e-health day in Sierre (TechnoArk) on June 3rd 2016. The event was well organized around big players (Boston Scientific, Roche), showing their vision of the technology and its implementation in their own business model, and startups (L.I.F.E. Corporation, Karmagenes) unveiling their innovations in the field. Moreover, other stakeholders like the health insurance Groupe Mutuel and government-financed agency CIPRET presented their real-world experiences. The event was closed by a panel discussion on the relationships between eDoctors and ePatients.

Globally, the vision of health is: health care providers will be able to improve health outcomes by working with digital patients (the data collected by sensors will be integrated and analyze to provide personalized treatments and consequently better outcomes). Several projects are developed: prosthesis control, diabetes management, vital signs monitoring for elderly people…

Below I summarize the key takeaways from the most interesting talks (not all of them).

The goal of the presentation was to provide clues on which business model is the most appropriate for digital health companies.

Medical technology companies create and develop products for patients but they really have to be aware of their ecosystem and the influences that will drive patients’ behavior.
Body sensors brought revolutionary tools to life. They are wireless, responsive, use mobile devices and allow data analysis to be performed. However, what is the real impact on health and disease management? Many companies have sensors supported by solid hardware, cloud data collection and a dashboard for mobile phone.

Despite the evolution of technology, we are still lacking clinical studies and proofs. In addition, the user dropout rate is pretty high (after 6 to 8 months, users abandon the sensor(s) and the app). Needless to say that, on top of all the previous disadvantages, the amount of data generated is extremely heavy and it is difficult to extract the most relevant indicators to analyze them.
However, the first digital health products helped open new perspectives and the potential of connections between all the stakeholders. Empowering and engaging healthcare providers is also one of the key benefits of the first digital health initiatives. Beyond those elements, what’s crucial to ensure adoption and reimbursement is to demonstrate the cost savings the technology could bring to the current health care settings. Doctors also have to support it and be convinced of the use and utility for their own patients.

All in all, the future of healthcare is expected to improve outcomes, reduce hospital readmission rate and control costs while maintaining care access.

The experience of the speaker allowed him to say which business models where the most appropriate to survive and thrive in that new field. He established 4 directions (that can be combined):
1. The patient is not a consumer. Generally speaking, he is not really willing to know that he’s ill. His main focus is to live. Family and friends are the most concerned about the patient’s health and wellbeing. Creating and developing tools that could ease the burden for the supportive people around the patient is generally well received and adopted.
2. Understand the business ecosystem. Knowing where to position the company is fundamental to avoid being stuck in a no man’s land. Focusing on lifestyle, coaching or care pathways is different and requirements increase massively for the care pathway segment.
3. The population is ageing and increasing. The health care system will have to support an additional financial burden with the passing of the years because we know that the majority of the costs is generated toward the end of life. Hospitals are paid today according to their own efficiency (shorter hospital stays as well as improved outcomes will generate higher payments from heath insurances). It is the OPM principle (Other People Money) meaning that the patient (who consumes) is not the payer. It is then crucial to find new solutions to reduce the costs.
4. Understanding the disease is more than fundamental. Compliance and adherence management and control in order to avoid hospital readmissions is one of the main issues of the whole healthcare system. Beyond that point, enhancing and improving the patient’s experience as well as the quality of care could well trigger new motivations for the patient to be compliant to his treatment.

Go beyond sensors-mobile-cloud-dashbord to include blockchain technology, augmented reality, internet of things… + any relevant technology or innovation that can bring value to the system. This value has to be demonstrated and proved as viable for the whole system.

The technology has to be integrated in the patient’s experience, nearly invisible, but not less complex.

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PATIENTS LIKE ME – THE POWER OF WE
By Chris Fidyk, Business Development Director Europe

Accelerating research and development of new treatment but also allowing patients to support each other and exchange life experience with a disease is the main goal of PatientsLikeMe. That network is maybe the smallest social network but the larger medical registry with more than 500’000 patients. Patientslikeme provides tools for patients to put their disease into context.

Today, there is a lot of momentum about patient centricity. It becomes more mainstream. Patients owe other patients their own experience (drugs, symptoms,…). Empowering people to express themselves about their journey in the disease. Then, when all the stories are aggregated, meanings and trends can be extracted.

It is also possible to see all people taking the same drug, its perceived effectiveness as well as some conversation analytics allowing to understand which symptoms are the most talked about, the treatment awareness, the barriers to access in addition to the reasons behind their treatment failure or cessation or continuation.

Data (experience and discussions) stay online and available even when the patient dies to enrich other patients’ lives. Regular video postings on Patientslikeme Youtube channel show patients sharing their own experience with the website and how it helps them cope with their disease.

How to meet the future? The lack of healthcare staff, the increase in chronic diseases and the rising healthcare costs are the challenges. How to manage them: accountability and empowerment for the patient and the consumer. Mastering your own health with less health and care services.

Today, technology-driven health is messy. The solutions have to be easy to use and secure for the patient.

The Personal Connected Health Alliance (PCHA) is at the forefront of health and wellness in today’s society, driving advancements in mobile and communications technologies, and the growing use of new devices, health trackers and apps by consumers and healthcare providers.

PCHA brings together the critical elements needed to ensure that these technologies are user-friendly, secure and can easily collect, display and relay personal health data. In PCHA’s vision for healthcare, consumers can use readily available technologies to access their personal health data, receive targeted health and wellness education, consult with healthcare providers and gain support from friends and family to improve their health.

PCHA focused on engaging consumers with their health via personalized health solutions designed for user-friendly connectivity (interoperability) that meet their lifestyle needs.

Business models are the main obstacles for interoperability to work.

Accu-Check Connect System from Roche provides an integrated meter, an app, and online tools for better diabetes management. The glucometer can share data in the cloud with the healthcare provider.

The main goal of Withings is to sell connected products to the general public. Those products can be bought in supermarkets and will help the consumer monitor vital signs such as weight, blood pressure,… Without being a doctor, the consumer can create a dashboard for his health. Changes in health are driven by him and, due to the fact that he generates data, he will be at the center of the data collection and analysis.

Those tools could also be used to enhance corporate wellness and engage employees through gamification. Employers will offer a connected bracelet and will organize a competition. Employers are however inherently screening employees for health issues and can analyze aggregated data to discover trends. Data around workout and physical activity are enriched by environmental and lifestyle inputs but also by stress management and absenteeism information.

In the e-health field, we are in the prevention area and also on new territories like personal health dashboard and employer focus on employees’ health.

E-health could be widely applied together with EHRs (Electronic Health Records). Linking EHRs to outcomes allow hospitals to monitor their performance to get more money from payers as they will limit the expenses for the system as a whole.

Withings also builds an open health data platform with the implementation of national observatories aggregating data from all the users. Those platforms will support research on connected devices with scientific publication and could stimulate partnerships and collaborations with other data sources.

Real world business case from concept to realization in partnership with the startup Ignilife.

Today more than 165’000 health apps are available with 40% dedicated to medical uses and 60% to wellness.
Regarding Switzerland, few initiatives have been developed to date. Groupe Mutuel would like to be the forerunner and not a follower in the field.

Ignilife is a French startup with a subsidiary in Switzerland. It is the perfect combination of entrepreneurship, medical skills and user experience. Ignilife has a previous experience with Malakoff Médéric, the leader for private health insurance in France.

Ignilife is a e-coaching platform based on people. It covers physical and emotional wellbeing. A first auto-evaluation is performed by the user in order to have a broad overview. An assessment is then released by the system with risk factors and advices to manage and lower their impact. Support and follow-up is provided as a selection of programs the user can choose from. He can also connect his devices.
Close to 300 video and audio plays are available. Each time a contest or challenge is won, it is input in the platform to show the progress and evolution.

It is essential to develop a rich, engaging and fun platform to keep the user motivated. The goals set are reasonable and not out of reach. There is a social media component where users can exchange experience and tips. More functionalities will be developed in the next future (health at work, back health, burnout prevention,…)Data protection is well managed, as all the data are stored in Switzerland on independent servers.

Groupe Mutuel pretends it does not use data collected by user but only on an aggregated basis. The rationale behind the implementation of such a project is the focus on prevention. It will help to keep health expenses at an acceptable level in the longer term.

Some stats:
25’000 Ignilife users (out of more than 1’100’000 insured people)
Mobile users connect much more than desktop users (2x)
91% did their auto-evaluation
61% engaged in a coaching program
47% changed their habits

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MANAGE MY DATA OR BE MANAGED BY MY DATA
By Stéphane Koch, Expert in Digital Experience

People like to measure their own weight, the calories they burnt, their heart rate,…
There is a real value added in using quantified self.
However, coherence is not always part of the measures and can distort statistics extracted out of the data. Sensors sometimes lose connection with the app leaving gaps or errors in measures. Improving apps with coherence system would be a big step further or even allowing the user to correct the data himself.

Quantified self generally has a positive impact on the user’s wellbeing but it can also generate stress if the progress takes time to emerge or if it stops. Knowing the scope of the technology as well as his body are fundamental.

The website DMD (in French) allows the evaluation of digital tools and the sharing of everyone’s user experience.

A real human adventure started and succeeded. The initiative was in 2 phases: recruitment and program on the same platform. It was completely free for the users. They just had to like the page, say they are interested and accept that all the posts written by CIPRET were the first they saw when they opened their Facebook app.

3 pillars of the program:
– Daily advices (personalized and not always linked to tobacco consumption)
– Group support (tips and experience sharing)
– Physical desire to smoke (will only last between 3 and 5 minutes => tips given to avoid relapse).

Professional support has been organized at 3 levels : the first one, community managers answer simple questions ; the second one, prevention experts take specific questions ; the third level, medical practioners take care of medical questions.

Some stats:
1’500 posts created
Support was on call during the whole week from 6am to 11pm
13’000 messages have been answered in the first weeks

The project started at the core of The Ark and focused on predictive models for tiredness, exhaustion and strain with the development of a garment.
That garment is equipped with sensors to monitor vital signs (it is medically accurate and there is no need of a smartphone). It allows total freedom.
It can be the third platform of communication (with the first 2 being computers and smartphones).

The medical accuracy is fundamental and it can be used in medical practice but also in sports. That garment has the same results as the invasive methods to analyze vital signs. It allows real life measurements and expansive communication (data omnipresence, diverse data analysis levels).

Software for personalized treatment dosage.
Unique treatment dosage works very well for simple drugs like paracetamol. Unfortunately, for oncology or chronic diseases drugs, which are much more complex molecules, it doesn’t work as well. It can lead to toxicity, side effects or no effect at all.

Therapeutic follow-up normally starts with a blood sample, pharmacology experts interact and guide the doctor in order to personalize the treatment.

A new software (EzeCHieL) do exactly the same but in a much faster and more practical way. The software can create the patient’s drug metabolism curve based on the EHR (Electronic Health Record) and medical databases. Some genetic characteristics or co-morbidities can lead to changes in drug blood concentration.

Interoperability (web interface) as well as confidentiality and data security are guaranteed (pseudonymisation, anonymisation).

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KARMAGENES – BE A GAME CHANGER MEET YOURSELF
By Kyriakos Kokkoris, CEO

Karmagenes is a game combining gene profiling and psychological analysis. Integrating genetics with psychology for improved personal development.

What defines who you are: what you are (DNA) and where you live (environment & perception).

Genetics meet psychology.

Human centric approach

Could be a network of personalities and connect locally.

Personal guide for career development, personal motivation, and physical as well as emotional well-being.

The market is not yet mature, a lot of opportunities are waiting to be seized.The patient is at the center of all motivations.

Despite new technologies, there is a lot to do to reach the patient. Few success stories (the CIPRET is however an excellent example).

What about doctors’ digital education? Patients are really driving the trend today; they stimulate doctors to be up to date and they push technology adoption.
Patients are very often looking for information online. Doctors should be prepared and help patients to use the right web sites in order to find appropriate and correct information. Doctors should also contribute and provide content on website to populate them with correct information.

All that information help to start interesting conversations. Information exchange should also be facilitated. The patient could be educated to provide the appropriate amount of information to avoid overload.

Patient should take part and be part of medical research. The patient is the least used resource in health care. With patients’ associations, precious information is stored and exchanged. That data can be analyzed.

The social component is extremely important for patients. Several of them like to share their experience and find support online. They also feel useful to provide information for other that have been diagnosed recently.

By giving access to medical and health information, communication and interactions with doctors will be easier and improved.

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A lot has been said and written about Theranos. My goal in this blog post is not to reinvent the wheel but to guide the reader toward meaningful and relevant web content about this story.

Like everybody else I was fascinated by the rise of Elizabeth Holmes without questioning the technology itself. Why? First, at that time, it was not one of the company I was considering for analysis (and investment opportunity) and, second, because sometimes technical words and concepts are difficult to understand and you do not have the time to dig further.

Needless to say that my interest grew stronger when I saw that the company and its technology as well as its founder were under scrutiny… As I’m very curious I tried to understand.

Beyond what has been shown and written in the media, it is key to understand the path that led the company in this situation and the potential mistakes made so far. It seems that more experience on board could have helped and maybe avoided misdirection.

Management errors could have doomed the company but the most problematic issue may well be the reputation: not only the company’s one but also the ones of all the other diagnostic start-ups in US and Europe. Investors will be much more skeptical. On the other hand, it also shows that due diligence and analysis (not only financial but mostly technical and scientific) must be done before investing in order to limit and frame the risk.

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An event has been organized in Geneva (Campus Biotech) in order to give an overview of funding opportunities in R&D in Switzerland. European as well as Swiss opportunities were explained, each time with insightful success stories and business cases.

That event combined both useful information together with relevant stories of companies having experienced the process, sometimes time-consuming but clearly worth the efforts.

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A lot has been said about the role of Apple in healthcare, the disruption it could bring and the need for it. If Steve Jobs was alive today, he would surely help the healthcare industry improve.

There is a lot of work and some progress are currently being made but they are slow to implement because evolution is not always seen as such (we all know about the learning curve…).

Apple is not the only company that could bring change and improvements, even disruption, in healthcare. All the technology companies are interested in this field and they will inevitably contribute to change the landscape.

What could Apple bring?

Analyze and integrate health data

The introduction of HealthKit in June 2014 was the start of a big wave of healthcare initiatives launched by Apple. Data collected via the HealthKit through wearables like the Apple Watch can be shared with the user’s doctor in order to improve the doctor-patient relationship. Data can then be integrated in the EHRs (Electronic Health Records) of the patient in order to enlarge the data collection.

Beyond data collection stands data analysis and it’s done with the help of the partnership with IBM Watson to support this effort.

Merging EHR and real-time data could enable the use of predictive analytics to anticipate health issues and diseases spread.

The implementation of EHRs could simplify and quicken the collection, use and consultation of medical data, especially in the case of emergencies. This could dramatically help to avoid medical errors due to the lack of specific retrospective information.

Partnerships

Apple has been and is still extremely smart in building strategic partnerships. 3 main partners worth keeping in mind:

IBM Watson: storage and analysis of raw data on IBM Watson Health Cloud for the data collected on HealthKit and ResearchKit.

Mayo Clinic: access to over 1 million patients in several countries around the world using dedicated proprietary EHR and communication tools for doctor-patient interactions.

The main goal of the HealthKit is to collect data from wearables and other connected devices to better monitor individual health. HealthKit also allows the integration of 3rd party apps and devices.

ResearchKit is an add-on to the HealthKit as it helps create apps to improve clinical trials and medical studies.

Apple Watch v. 2.0 and new wearables

The new versions of the Apple Watch could potentially be developed into more sophisticated health-tracking devices with improved heart rate monitor. Moreover, thank to non-invasive technologies, new vital signs could to be captured and analyzed more accurately.

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Nearly all of the companies already published their 2015 financial results. Performances varied widely and some clearly outperformed others as in any industry.

The 2015 best company is Gilead: what an amazing performance! In less than 2 years, it reached the Top 15 Pharma companies. More than USD 19 billion of sales had been generated from Harvoni and Sovaldi, both disruptive drugs against hepatitis C. 58% of 2015 sales came from those 2 products. Diversification will be the next challenge for the company.

The table below summarizes the main financial data points for 2015:

Teva has not yet published its results at the time of my post. I’ll update it later on.

*For Takeda, the company released only its 9-month results and for comparison purposes I extrapolated the 9-month into a 12-month period.

After populating the table, 2 aggregates have been computed:

Total sales in 2015 from Top 15 Pharma companies: USD 487 billion

Total R&D expenditures in 2015 from Top 15 companies: USD 82.5 billion

All in all, the big names of the industry spent close to 17% of their sales in research and development.

When we look at the 4th column in the table, year over year growth in constant currencies is between 0 and 8% apart for 2-3 companies like AbbVie (linked to the Pharmacyclics acquisition in May 2015), Bristol-Myers Squibb and Lilly.

Generally speaking, the pharmaceutical industry is still a cash-rich and good performing industry. More challenges will probably come from pricing pressures around the world (and this time not only Europe or Japan, but also from the USA).

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Today using opioids to treat chronic pain seems quite obvious for a lot of clinicians. This trivialization, beyond the responsibility of both the clinician and the patient, is responsible for the dramatic increase of opioid misuses and overdoses.

An excellent article written by Dr. Daniel Alford in the last issue of NEJM proposed smart solutions. Prescriber education is one of them. It would allow a more specific approach to addressing the opioid-misuse epidemic: benefit-risk assessment of patient’s needs and care individualization. It should be completed with patient close follow-up and monitoring as well as the careful evaluation at each encounter of whether to start, continue, decrease, increase or stop the treatment.

Training should start early in the medical education and students have to be aware of the best practices for that type of prescription. All the options for chronic pain management have to be taught and not only to doctors but to all healthcare providers in order to tackle the lack of awareness and education in the field.

Beyond drugs, other alternatives should be tested and proposed, especially when an opioid-based treatment is stopped. Explanations have to be provided in order to reassure the patient that his/her pain is manageable without this type of drugs.

The whole discussion, and a whole lot of other healthcare themes, are closely linked to the doctor-patient relationship. Trust, collaboration and open discussion are all key in order to have the best outcomes for the patient.

As a conclusion, I would like to invite you to watch the fantastic talk given by Elliot Krane, an expert in chronic pain about how this disease invades the body, what are the treatment options and what’s next.